An unusual foreign body in the upper aerodigestive tract: esophageal obstruction due to bran impaction.

Foreign bodies of the upper aerodigestive tract are common problems encountered by the otolaryngologist and general surgeons. While the diagnosis seems straightforward, it is sometimes delayed until after serious complications have occurred. The treatment of choice is endoscopic retrieval under general anesthesia. The procedure should be preceded by the completion of appropriate studies (radiographic and other specifically indicated for the patient) planned and performed by the endoscopy team. Time invested in preparation and planning will usually yield a speedy recovery of the patient. Bran is a natural fiber that undergoes considerable expansion and thickening when hydrated. Due to this property, it has been used in "weight loss" tablets that in the stomach undergo expansion and are expected to cause early satiety. These tablets are usually marketed as over-the-counter (OTC) diet products by a number of pharmaceutical manufacturers. These supplements consisting primarily of dietary fibers, so common and inoffensive-seeming, rarely may have severe side effects, such a sudden esophageal obstruction. We report a case of a bran dietary product impacted in the cervical esophagus in a 45 year old woman, presenting as an emergency complaining of retrosternal discomfort and difficult to swallow or drink. The technique for removal of such object that is also reported.

Our experience in Helicobacter pylori infection and gastric MALToma.

OBJECTIVE: A number of recent studies have expanded our understanding of Helicobacter pylori (Hp) infection and of the pathogenesis of MALT lymphoma. The purpose of this paper is to perform a retrospective analysis of the clinical characteristics of gastric MALT lymphoma and its relationship with H. pylori infection in authors' experience. MATERIALS AND METHODS: We report nineteen patients observed during 10 years, presenting with gastric MALTomas at any stage. The staging classification and the presence of H. pylori infection have been assessed, and the chosen therapy also. RESULTS: The most part of our patients underwent surgery, still now resulting the most effective therapy. None of the patients had eradicating therapy due to their poor compliance and because the most part of cases were observed before the time of clinical validation of such treatment. CONCLUSIONS: In our series, surgery was effective for treatment of gastric MALT lymphomas. Surgery and chemotherapy remain, in accord with literature data, the best treatment for gastric MALTomas. Hence, because Hp may play a role in the development of such pathology in certain patients, antibiotic treatment for Hp eradication should not be discouraged in these patients, especially in them with low grade gastric MALT lymphomas. In fact, the failure of this therapy will not modify either survival or later recourse to surgical and/or radio- and chemotherapy.

Helicobacter pylori infection and gastric MALTomas: an up-to-date and therapy highlight.

During the last 20 years Helicobacter pylori (Hp) has been, undoubtly, the star of gastroenterology and microbiology, so much to deserve the "Nobel prize 2005" for biology and medicine to its discoverers. More recently, an increased interest arised on Hp and its linkages with other medical fi elds such as immunology, surgery and dentistry. The outcome of the pathologies due to such bacterium is dependent on many factors, including bacterial genotype, host physiology and genetics, and environmental factors such as diet. In spite of its clear involvement in some pathologies like acute and chronic gastritis, peptic ulcer and gastric cancer, very little is known about another pathology recently proved to be closely associated to the infection by Hp: the gastric MALToma, which account for 7% of all newly diagnosed non-Hodgkin's lymphoma. The chronic infection of the gastric mucosa from Helicobacter pylori primes a complex pathogenic process which could determine the onset of the gastric cancer through some intermediary steps. On these bases, in 1994, the International Agency for Cancer Research (IARC) defined this bacterium a "class I carcinogenic agent" for gastric cancer. The MALT lymphomas are the most frequent lymphoid neoplasms of the digestive tract; we can also observe other and more rare lymphomatous tumours with specific clinical patterns, like the T-lymphoma associated with lymphomatous polyposis and enteropathy. The development of gastric lymphomas is usually preceded by the acquisition of lymphatic tissue, after inflammatory stimuli and particularly after the infection from Hp, which organizes itself with the characteristics of the MALT. Recently, a number of papers have highlighted the remarkable efficacy of Hp eradicating therapy in patients with low-grade MALT lymphoma of the stomach without other modalities, e.g. surgery and systemic chemotherapy. The aim of this study is to be helpful for a comprehensive understanding the possible connections between Hp and gastric MALT lymphoma, evaluating the best therapy strategies, surgical and non surgical, actually available for its treatment.

Gastroesophageal reflux disease and dental erosion. A case report and review of the literature.

The term gastroesophageal reflux refers to the regurgitation of gastric material into the oesophagus. When the reflux is accompanied by inflammation of the oesophageal mucosa and extra-oesophageal symptoms the complaint is classified as a pathological condition called gastroesophageal reflux disease (GERD). GERD is caused by backward expulsion of the gastric content into the oesophagus. It is characterized by a complex clinical picture that may include lesions of the oesophageal mucosa and lesions of a different nature and severity of the respiratory and stomatognathic apparatus. GERD is considered to be a proteiform complaint induced by many different pathogenetic mechanisms resulting in a wide spectrum of clinical and morphological manifestations secondary to the reflux. Among extra-oesophageal manifestations, those affecting the dental structures are particularly important, owing to their aesthetic and functional implications on the stomatognathic apparatus. The Authors present a recently observed and treated case of GERD with associated severe aesthetic lesions of the frontal teeth. The currently available treatment options for the primary disease are examined, as well as the possible forms of conservative treatment of the affected teeth.

[Nutritional problems in the surgical patients with head and neck tumours. Literature review and personal experience]. / Problematiche nutrizionali nei pazienti chirurgici con patolo- gie oncologiche del distretto cervico-cefalico. Revisione della letteratura alla luce dell'esperienza professionale.

During the last years the importance of the correct nutritional assessment as a part of the therapeutic process of the human pathologies has a greatly increased relevance. Still more in oncology, such relationship among nutritional assessment and good result of the therapeutic treatment have a fundamental importance. Among the neoplastic diseases those of the head and the neck result to be particularly aggressive, both for their nature and for the particular anatomical organization of such body areas, and the affected patients also need a precise evaluation of the nutritional assessment to obtain an optimal therapeutic result. On the basis of such premises and to their own clinical experience, the authors describe the main nutritional problems of the patients with tumours of the head and the neck and the possible therapeutic solutions.

[Treatment of bowel obstruction in our own experience]. / II trattamento dell'occlusione intestinale nella nostra esperienza.

The intestinal obstruction accounts for the 20% of the acute surgical affections and represents one of the most common indications for the urgent surgery. The clinical scenarios of the intestinal occlusion are rather diversified, with a series of signs not always contemporary present, since they are related to the site (left colon in most cases) and type (neoplastic, by adhesions, or hernia complication) of the obstruction. The authors report their experience about 149 patients clinically observed and treated along a period of 7 years and 3 months.

[Gardner syndrome: clinical and epidemiologic up to date]. / Attualità cliniche nella sindrome di Gardner: contributo casistico.

In 1950 EJ Gardner first described a new syndrome characterized by (1) familial colonic polyposis, (2) multiple osteomas, (3) soft tissues cysts and (4) fibrous lesions. Thereafter, in 1975 Watne and coll. have demonstrated the occurence, in patients affected by Gardner syndrome, of the early onset of osteomas and dental inclusions in maxillary bones. Gardner syndrome is actually considered a severe life treathening condition due to the poor quality of life and the evolutive pattern of colonic polyps to colon cancer in 100% of cases. The aim of this paper is the review of the pathophysiologic and clinical aspects of Gardner syndrome, with report of institutional clinical data about epidemiology and clinical presentation of such condition, attempting to elaborate a clinical protocol for early detection of that.

[Advances in diagnosis and therapy of breast cancer between the 20th and the 21st centuries]. / L'evoluzione della diagnostica e della terapia chirurgica del carcinoma mammario tra XX e XXI secolo.

During the last two decades several new data have been acquired about tumor biology and therapy. Breast cancer is one of the more common cancers occurring, determining life threatening and depression in affected females. By the way a great interest has been developed during the time attempting to reach the earliest diagnosis and the more conservative treatment. However, breast cancer is now considered as a disease which meet the interests of several specialists (oncologists, surgeons, radiologists, and so), all dedicated to reduce the consequences of such pathology. The aim of this review is the resume of the progresses made in the last century about breast cancer knowledge.

[Expression of epithelial oncoproteins in large intestine neoplasms]. / Espressione di oncoproteine epiteliali in neoformazioni del grosso intestino.

The high incidence of the colorectal cancer in the industrialized countries has drawn the interest of the scientific community to detect and investigate its morphologic precursors. Growth factors and oncoproteins could be useful to investigate the morphologic and biologic evolution of precancerous lesions of the large bowel. Therefore the Authors report the results obtained from 30 selected patients with hyperplastic and adenomatous polyps, and different histotypes of colorectal cancer, investigated using the EGF-r and p62 protein expression. The results show the potential usefulness of such markers to evaluate the biology of intestinal tumors.

[Argyrophilic nucleolar organizer regions (AgNORs) as malignancy biomarkers in colorectal neoplasms]. / Studio delle regioni organizzatrici argirofile del nucleolo (AgNORs) nelle neoformazioni colo-rettali quale indice di malignità biologica.

The high incidence of intestinal cancer has aroused strong interest in researching and trying to discover its morphologic precursors. In this contest the study of nucleolar organizing regions could be interesting as prognostic factor for bowel neoplasm and useful for differential diagnosis of intestinal diseases. The Authors report on the results of their study performed on 30 selected samples from 6 different bowel lesions.

[Carcinoma of unknown origin++ with latero-cervical metastasis. Diagnostic problems. Retrospective analysis of 110 cases of latero-cervical tumefaction]. / Carcinoma occulto con metastasi latero-cervicali. Problematiche diagnostiche. Analisi retrospettiva su 110 casi di tumefazioni latero-cervicali.

The cervical region, despite to its little extension, is very important by the surgical and anatomical point of view. This region, occupied by a lot of organs, sometimes is the site of metastasis from carcinomas located in various parts of the body. In some cases the origin site of cancer stays unknown. The aim of this paper is the retrospective analysis of 110 cases of latero cervical swellings and the related problems of differential diagnosis.

[Role of mast cells in the physiopathology of gastric lesions caused by Helicobacter pylori]. / Ruolo dei mastociti nella fisiopatologia delle lesioni gastriche indotte da Helicobacter pylori.

Routine observation of stained histological preparations for the detection of Helicobacter pylori (HP) has shown a variable presence of mast cells in the mucosa of patients suffering from gastritis. Our aim was to verify whether any correlations exist between HP positivity, type of gastritis and presence of mast cells. We examined 300 bioptic fragments of gastric mucosa obtained by diagnostic oesophagogastroduodenoscopy. The study population consisted of 88 patients with chronic superficial gastritis and 12 with chronic atrophic gastritis (59 males and 41 females). HP detection was performed on Giemsa-stained preparations. Mast cell detection was performed on Giemsa- and PAS-stained preparations. Seventy percent of chronic superficial gastritis cases were found to be HP-positive and mast cells were present in 90% of these and absent in 10%. In the chronic atrophic gastritis cases 50% were HP-positive and mast cells were present in 50% and absent in the rest. HP is regarded as the causal agent of type B gastritis. On the basis of our data a significant correlation was found (86%) between HP-positivity and presence of mast cells in the inflammatory gastric mucosa.

[Assessment of hepatocyte AgNORs expression in chronic hepatopathy]. / Valutazione della espressione di AgNORs epatocitarie in corso di epatopatie croniche.

The high incidence of liver chronic diseases has aroused strong interest in researching and trying to discover the biomolecular basis. In this context the study of nucleolar organizing regions could be interesting as a prognostic factor for chronic hepatitis and for liver neoplastic disease. The Authors report on the results of their study performed on 39 selected samples from 4 different inflammatory hepatic disorders.

[Pica in psychotic patients: an unusual cause of acute abdomen]. / Il picacismo nei pazienti psicotici: una inconsueta causa di addome acuto.

Pica is a pathologic craving for substances not commonly regarded as foods. In this study the authors report their experience about five cases presented with an acute abdomen following foreign bodies ingestion by patients mentally handicapped. Therapeutic treatment was emergency laparatomy with postoperative morbidity of 40% and mortality of 40%. It is hoped that specific drug therapy with more aggressive surgical treatment will reduce the mortality significantly.

[Rare neoplasms of the breast: our experience concerning nonepithelial malignant breast tumors]. / Neoplasie rare della mammella: la nostra esperienza dei tumori maligni mammari non epiteliali.

The Authors report their experience about some clinical cases of uncommon breast neoplasms observed at the Division of Surgical Pathology, referring particularly on non epithelial malignant tumors. Signalled more meaningful anatomopathologic elements, they describe diagnostic difficulties and therapeutic of such neoplasias; for their rarity they would deserve a study more deepened finalized to the formulation of diagnostic and therapeutic guidelines as so as in the most common breast carcinoma.

A survival regression analysis of prognostic factors in colorectal cancer.

BACKGROUND: Many prognostic factors of colorectal cancer are known but their actual clinical validity is still uncertain. The aim of the present study was to verify, on the basis of our experience, the prognostic validy of variables for survival by using survival regression analysis. METHODS: From January 1978 to December 1986 the prognostic factors for 192 patients were analysed. These patients had undergone surgical resection for colorectal cancer. The follow up was completed in every patient by the end of December 1992, with a median follow up of 10 years (range 6-14 years). The prognostic factors considered in the statistical analysis were age, sex, size of tumour, site, grade, direct spread, node involvement and stage (according to Astler-Coller and pTNM). RESULTS: Of the prognostic factors, sex was the only one not to show any prognostic significance. In the survival regression analysis we have used an accelerated failure time model (equivalent to the Cox proportional hazard model); age, grade and stage were significant covariables. CONCLUSIONS: Although clinical pathological staging (pTNM) appears as a pre-eminent prognostic factor, and as our analysis shows, it needs a further variable (grading), which has been shown to affect the prognosis in a significant way.

[Immune evaluations in cancer patients after colorectal resection]. / Valutazioni immunitarie in pazienti neoplastici dopo resezione colo-rettale.

The authors report a protocol of immunomodulation and monitoring of the intestinal function in coloresected patients using fermented milk (yoghurt). Intestinal immunity was evaluated with respect to CD4+ cells armed with secretory intestine-derived IgA, and to CD8+ cells armed with IgG aiming to an additional effect in the host protection against Gram-negative strains, such as Salmonella typhi, whose particularly high incidence in Apulia accounts for an increased immunitary activity. Ten patients (six females, four males), age ranging from 44 to 85 years, who underwent surgery between 1989 and 1992, each of whom had been prescribed a daily ration of 500 gr skimmed yoghurt for one month, were observed. The authors suggest that yoghurt may determine a higher release of gamma-IFN with activation of CD4+ and CD8+ cells. The Lactobacillus stimulation of the B lymphocytes of the Peyer plates seems to induce an increased production of secretory IgA that bind to the CD4+ surface, and of IgG (as an anamnestic response to challenge with yoghurt lactobacilli). Coloresected patients show an immunitary deficiency related to the Gram+ bacterial flora reduction and consequently a decrease in the physiological stimuli. Although these date concern a limited sample, the authors stress the importance of the restoration of bacterial flora in coloresected patients.

[Report of a case of malignant atrophic papulosis or Degos disease]. / Su un caso di papulosi atrofica maligna (P.A.M.) o malattia di Degos.

The Authors report an exceptional case of Atrophic Malignant Papulosis (P.A.M.) or Degos disease, presenting as acute abdomen with ileal and multiple colic perforations. The disease is due to an occlusive, progressive, thrombotic vascular pathology affecting different parts of the body and may bring to death. Usually this rare disease presents with typical multiple papulous skin lesions, followed by a systemic involvement of the digestive, nervous, and visive tracts. Peritonitis and cerebral infarction are the most frequent causes of death.

[Acute ileitis due to Ascaris lumbricoides]. / Ileite acuta da "Ascaris lumbricoides".

The authors report their experience of two cases of acute ileitis with an obstructive complication due to "Ascaris lumbricoides". The distinctive features were, in the first case, the pathogenic mechanism responsible of the occlusion, and in the second one, the need of a long term follow-up. The latter, especially in the "aspecific forms", often allows an etiological diagnosis difficult even at laparotomy. Indicating the most frequent causes of surgical complications found in ileitis, which is a medical disease easily curable by medical and dietetic means, the authors confirm the difficulties of an etiological diagnosis and surgical treatment, increased by the rarity of the disease.

[Cystosarcoma phyllodes of the breast: clinical cases]. / II cistosarcoma filloide della mammella: contributo clinico.

The authors report their experience in the management of 8 cases of cystosarcoma phylloides of the breast observed between January 1979 and December 1986 in the Surgical Department of the University of Bari. This uncommon breast pathology, which stands halfway between benign (adenofibromas) and malignant (carcinomas) tumors presents considerable difficulties in terms of diagnosis particularly problematic for the small-sized lesions. The authors stress the need of a surgical treatment which takes into account women aesthetic desire assuring at the same time a complete exeresis. The latter includes the sacrifice of at least 1 cm thick normal breast tissue to prevent the frequent local relapses.